From Research to Practice: HIV/AIDS in Thailand Thira Sirisanthana, MD Chiang Mai University.
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Transcript of From Research to Practice: HIV/AIDS in Thailand Thira Sirisanthana, MD Chiang Mai University.
From Research to Practice: HIV/AIDS in
Thailand
Thira Sirisanthana, MDChiang Mai University
Outline: Use the HIV/AIDS epidemic to demonstrate
how RESEARCH help form EVIDENCE-BASED PUBLIC HEALTH POLICY in Thailand
The Thai epidemic in relation to the world’s Thailand’s success from the beginning of the
epidemic until 2551 Commercial sex workers PMTCT Access to HAART
Thailand’s remaining problem areas: IDU, MSM, Youth (and low usage of VCT)
LESSONS LEARNED for กรมควบค�มโรค
Initial Reports
June 5, 2524: 5 cases of PCP in gay men from UCLA (MMWR)
July 3, 2524: 26 additional cases Dec 10, 2524: 3 NEJM papers
describe cases
Gottlieb MS NEJM 2001;344:1788-91From: Glesby MJ, NY/NJ AIDS Education and Training Center
Other Early Developments (1) 2525:
Term “AIDS” coined First cases in women reported First transfusion and vertically transmitted cases reported
2526: Isolation of a retrovirus from a patient with AIDS by
Montagnier’s group
2527: Detection of HTLV-III in pts with and at risk for AIDS (Gallo)
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Other Early Developments (1) 2525:
Term “AIDS” coined First cases in women reported First transfusion and vertically transmitted cases reported
2526: Isolation of a retrovirus from a patient with AIDS by
Montagnier’s group
2527: Detection of HTLV-III in pts with and at risk for AIDS (Gallo)
From: Glesby MJ, NY/NJ AIDS Education and Training Center
2527: The first reported case of AIDS in Thailand
Other Early Developments (2)
2528: FDA approves first commercial HIV antibody test
2529: NIH establishes the AIDS Clinical Trials Groups
(ACTG and PACTG)
2530: AZT = first antiretroviral approved by FDA
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Other Early Developments (2)
2528: FDA approves first commercial HIV antibody test
2529: NIH establishes the AIDS Clinical Trials Groups
(ACTG and PACTG)
2530: AZT = first antiretroviral approved by FDA
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Thai institutes that are research sites for ACTG and PACTG (now called IMPAACT)
IMPAACT: Siriraj Hospital, Chonburi Hospital, Prapokklao Hospital, Chiang Rai Hospital, Bhumibol Adulyadej Hospital, Phayao Hospital, Chiang Mai University
ACTG: Chiang Mai University
Other Early Developments (2)
2528: FDA approves first commercial HIV antibody test
2529: NIH establishes the AIDS Clinical Trials Groups
(ACTG and PACTG)
2530: AZT = first antiretroviral approved by FDA
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Other U.S. NIH–associatied AIDS Thai research sites
Treatment trials: HIVNAT Thai Red Cross (CIPRA and INSIGHT)
Prevention trials: Chiang Mai University (HPTN)
Prevention of mother to child transmission: Thai MOPH / PHPT
Vaccine trials: Thai MOPH (Rayong-Chonburi), Chiang Mai University (HVTN)
Voluntary counseling and testing: Chiang Mai University
Other Early Developments (2)
2528: FDA approves first commercial HIV antibody test
2529: NIH establishes the AIDS Clinical Trials Group
2530: AZT = first antiretroviral approved by FDA
Other Early Developments (2)
2528: FDA approves first commercial HIV antibody test
2529: NIH establishes the AIDS Clinical Trials Group
2530: AZT = first antiretroviral approved by FDA
2531: Beginning of the Thai HIV/AIDS epidemic
Number of new HIV infections by transmission mode
0
20,000
40,000
60,000
80,000
100,000
120,000
Num
ber
new
infe
ctio
ns in
last
yea
r Injection DrugUserMale sex withmaleMale from sexworkerMale from wife
Sex worker
Female fromHusbandExtramarital
From: Peerapatanapokin W, Thai MOPH
Current State of the Thai Epidemic
1,100,000 adults have been infected since start
560,000 adults have died of AIDS 550,000 adults currently living with
HIV or AIDS 14,000 new infections (adults &
children) will occur this year 46,000 adults currently living with
AIDS illness.
From: Peerapatanapokin W, Thai MOPH (2007)
Other Early Developments (2)
2528: FDA approves first commercial HIV antibody test
2529: NIH establishes the AIDS Clinical Trials Group
2530: AZT = first antiretroviral approved by FDA
2531: Beginning of the Thai HIV/AIDS epidemic
Early Antiretroviral Therapy (1)
2534-35: ddI, ddC approved Sequential monotherapy
2536: Concorde: no difference in clinical endpoints
over 3 yrs with early vs. deferred AZT
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Early Antiretroviral Therapy (1)
1991-92: ddI, ddC approved Sequential monotherapy
1993: Concorde: no difference in clinical endpoints
over 3 yrs with early vs. deferred AZT
From: Glesby MJ, NY/NJ AIDS Education and Training Center
1992-1995: AZT monotherapy available to selected (few) Thai AIDS patients
Early Antiretroviral Therapy (2)
2537: ACTG 076: AZT reduces mother-to-child
transmission of HIV Dual nucleoside therapy better than
monotherapy (Delta, ACTG 175, ZDV/3TC)
2537-38: era of dual combination therapy
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Early Antiretroviral Therapy (2)
2537: ACTG 076: AZT reduces mother-to-child
transmission of HIV Dual nucleoside therapy better than
monotherapy (Delta, ACTG 175, ZDV/3TC)
2537-38: era of dual combination therapy
From: Glesby MJ, NY/NJ AIDS Education and Training Center
2541 – “Bangkok study” conducted at the Queen Sirikit Children Hospital of the Thai MOPH shows effectiveness of short-course AZT
Early Antiretroviral Therapy (2)
2537: ACTG 076: AZT reduces mother-to-child
transmission of HIV Dual nucleoside therapy better than
monotherapy (Delta, ACTG 175, ZDV/3TC)
2537-38: era of dual combination therapy
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Early Antiretroviral Therapy (2)
2537: ACTG 076: AZT reduces mother-to-child
transmission of HIV Dual nucleoside therapy better than
monotherapy (Delta, ACTG 175, ZDV/3TC)
2537-38: era of dual combination therapy
1995-2000: Dual therapy available to a few Thai patients, but the majority are on no antiretroviral treatment
1995-2000: Dual therapy available to a few Thai patients, but the majority are on no antiretroviral treatment
2538-43: Dual therapy available to a few Thai patients, but the majority are on no antiretroviral treatment
The New Treatment Era
2538-39: HIV viral load testing became
available Clinicians could directly assess the effect
of antiretrovirals on viral replication (HIV RNA)
First protease inhibitors approved by FDA
From: Glesby MJ, NY/NJ AIDS Education and Training Center
The New Treatment Era
2538-39: HIV viral load testing became
available Clinicians could directly assess the effect
of antiretrovirals on viral replication (HIV RNA)
First protease inhibitors approved by FDA
2538-43: Dual therapy available to a few Thai patients, but the majority are on no antiretroviral treatment
The New Treatment Era
2538-2539: HIV viral load testing became
available Clinicians could directly assess the effect
of antiretrovirals on viral replication (HIV RNA)
First protease inhibitors approved by FDA
From: Glesby MJ, NY/NJ AIDS Education and Training Center
0
5
10
15
20
25
30
35
40
2538 2539 2540 2541 2542 2543 2544
Dea
ths
per
100
per
son
-yea
rs
0
25
50
75
100 Percen
tage o
f patien
t-days o
n A
RT
DEATHS
USE OF ART
Mortality vs. ART utilization
Palella F et al. 8th CROI 2001; abstract 268b.
AIDS Mortality Rates: 2539-44
From: Glesby MJ, NY/NJ AIDS Education and Training Center
Number of projected annual deaths: effect of the Thai MOPH free HAART program
0
10,000
20,000
30,000
40,000
50,000
60,000
From: Peerapatanapokin W, Thai MOPH
Thai government free HAART program started in 2543-6. About 100,000 are receiving treatment as of 2551
Thailand’s success in the control of AIDS
From: Björkman H, UNDP
From: Pattarakulwanich S, Thai Ministry of Public Health
Thailand prevented millions of AIDS death
From: Pattarakulwanich S, Thai Ministry of Public Health
Outline: Use the HIV/AIDS epidemic to demonstrate
how RESEARCH help form EVIDENCE-BASED PUBLIC HEALTH POLICY in Thailand
The Thai epidemic in relation to the world’s Thailand’s success from the beginning of the
epidemic until 2551 Commercial sex workers PMTCT Access to HAART
Thailand’s remaining problem areas: IDU, MSM, Youth (and low usage of VCT)
LESSONS LEARNED for กรมควบค�มโรค
Injecting drug use in Thailand The actual number of users who inject drugs is
not known Estimates range from 100,000 to 250,000
addicts Most of them are males (around 90 percent)
and mostly aged between 20-24 years
From: Khondkar L, Tackling HIV/AIDS among Thai IDU (www.aids2006.org/Web/TUAE0103.ppt)
HIV/AIDS among IDUs About one quarter of all new infections is
occurring through unsafe injecting drug use
Median HIV prevalence among IDUs is as high as 50%
HIV is a major killer of IDUs in Thailand The situation has remained consistent for
nearly 15 years The high prevalence is due to the
frequency of injecting, widespread sharing of needles, and imprisonment of IDUs
From: Khondkar L, Tackling HIV/AIDS among Thai IDU (www.aids2006.org/Web/TUAE0103.ppt)
Limitations in addressing HIV/AIDS among IDUs
Little collaboration between drug control programs and HIV/AIDS response
Narcotic Control legislation does not pay attention to the prevention of HIV among IDUs
Lack of communication between AIDS control authorities, Office of Narcotics Control Board, and those working in drug treatment
Technical skills are not very high in addressing HIV/AIDS among drug users
From: Khondkar L, Tackling HIV/AIDS among Thai IDU (www.aids2006.org/Web/TUAE0103.ppt)
Summarizing the challenges Criminal justice approach taken by government Non-availability of harm reduction programs Limited prevention coverage Ineffective treatment interventions Discriminatory practices in society and health
care facilities Lack of opportunity for IDUs to take part in
decision making process affecting them
From: Khondkar L, Tackling HIV/AIDS among Thai IDU (www.aids2006.org/Web/TUAE0103.ppt)
HIV prevalence among MSM – Bangkok
From: Thai MOPH, U.S. CDC, Thai Red Cross, Family Health International, and Purple Sky
HIV in Thai teenagers 2001 HIV positive 7.1 %2002 HIV positive 7.9 %2003 HIV positive 13.6 %
Anonymous clinic : Thai Red Cross, Bangkok
Casual sex For male group, the value changed from
5% in 1996 to 20% in 2004 For the female, the value changed from
2% in 1996 to 10% in 2004
From: Peerapatanapokin W, Thai MOPH
Outline: Use the HIV/AIDS epidemic to demonstrate
how RESEARCH help form EVIDENCE-BASED PUBLIC HEALTH POLICY in Thailand
The Thai epidemic in relation to the world’s Thailand’s success from the beginning of the
epidemic until 2551 Commercial sex workers PMTCT Access to HAART
Thailand’s remaining problem areas: IDU, MSM, Youth (and low usage of VCT)
LESSONS LEARNED for กรมควบค�มโรค
Lessons learned for กรมควบค�มโรค (1): Use past success as a guidance, even in
the new role as an “academic” Department
Many “facts/evidences” have already been published
Identify specific “gaps” that the Department has to do research to guide MOPH policies
Lessons learned for กรมควบค�มโรค (2) : Research should be “need-driven” NOT
“investigator-driven” The Department needs “block grant” NOT
grant for individual proposal and needs to set specific themes and objectives identified as MOPH priorities
Thank you